Vascularized Composite Allograft Tolerance Across MHC Barriers in a Large Animal Model

Authors

  • D. A. Leonard,

    1. Transplantation Biology Research Center, Massachusetts General Hospital, Harvard Medical School, Boston, MA
    2. Division of Plastic and Reconstructive Surgery, Massachusetts General Hospital, Harvard Medical School, Boston, MA
    3. Department of Plastic and Reconstructive Surgery Research, University of Manchester, Manchester, UK
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    • These authors have contributed equally to this work.
  • J. M. Kurtz,

    1. Transplantation Biology Research Center, Massachusetts General Hospital, Harvard Medical School, Boston, MA
    2. Department of Biology, Emmanuel College, Boston, MA
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    • These authors have contributed equally to this work.
  • C. Mallard,

    1. Transplantation Biology Research Center, Massachusetts General Hospital, Harvard Medical School, Boston, MA
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  • A. Albritton,

    1. Transplantation Biology Research Center, Massachusetts General Hospital, Harvard Medical School, Boston, MA
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  • R. Duran-Struuck,

    1. Transplantation Biology Research Center, Massachusetts General Hospital, Harvard Medical School, Boston, MA
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  • E. A. Farkash,

    1. Department of Pathology, Massachusetts General Hospital, Harvard Medical School, Boston, MA
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  • R. Crepeau,

    1. Transplantation Biology Research Center, Massachusetts General Hospital, Harvard Medical School, Boston, MA
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  • A. Matar,

    1. Transplantation Biology Research Center, Massachusetts General Hospital, Harvard Medical School, Boston, MA
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  • B. M. Horner,

    1. Transplantation Biology Research Center, Massachusetts General Hospital, Harvard Medical School, Boston, MA
    2. Division of Plastic and Reconstructive Surgery, Massachusetts General Hospital, Harvard Medical School, Boston, MA
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  • M. A. Randolph,

    1. Division of Plastic and Reconstructive Surgery, Massachusetts General Hospital, Harvard Medical School, Boston, MA
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  • D. H. Sachs,

    1. Transplantation Biology Research Center, Massachusetts General Hospital, Harvard Medical School, Boston, MA
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  • C. A. Huang,

    Corresponding author
    1. Transplantation Biology Research Center, Massachusetts General Hospital, Harvard Medical School, Boston, MA
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    • These authors have contributed equally to this work.
  • C. L. Cetrulo Jr.

    Corresponding author
    1. Transplantation Biology Research Center, Massachusetts General Hospital, Harvard Medical School, Boston, MA
    2. Division of Plastic and Reconstructive Surgery, Massachusetts General Hospital, Harvard Medical School, Boston, MA
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    • These authors have contributed equally to this work.

Abstract

Vascularized composite allograft (VCA) transplantation can restore form and function following severe craniofacial injuries, extremity amputations or massive tissue loss. The induction of transplant tolerance would eliminate the need for long-term immunosuppression, realigning the risk–benefit ratio for these life-enhancing procedures. Skin, a critical component of VCA, has consistently presented the most stringent challenge to transplant tolerance. Here, we demonstrate, in a clinically relevant miniature swine model, induction of immunologic tolerance of VCAs across MHC barriers by induction of stable hematopoietic mixed chimerism. Recipient conditioning consisted of T cell depletion with CD3-immunotoxin, and 100 cGy total body irradiation prior to hematopoietic cell transplantation (HCT) and a 45-day course of cyclosporine A. VCA transplantation was performed either simultaneously to induction of mixed chimerism or into established mixed chimeras 85–150 days later. Following withdrawal of immunosuppression both VCAs transplanted into stable chimeras (n = 4), and those transplanted at the time of HCT (n = 2) accepted all components, including skin, without evidence of rejection to the experimental end point 115–504 days posttransplant. These data demonstrate that tolerance across MHC mismatches can be induced in a clinically relevant VCA model, providing proof of concept for long-term immunosuppression-free survival.

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